Glut Of Doctors, Nurses Predicted By Commission

Study Recommends Closing 20% Of U.s. Medical Schools

WASHINGTON — The trend to more efficient, managed-care health systems is reducing demand for doctors, nurses and pharmacists, a study said Thursday.

The study, issued by the San Franciso-based Pew Health Professions Commission, warns of a massive glut of health-care workers ahead, and recommended that 1 in 5 of the nation's medical schools be closed over the next 10 years.

The 21-member panel predicted that market-driven changes in health-care delivery will result in up to half of all U.S. hospitals being shuttered by 2000, along with the "loss of perhaps 60 percent of hospital beds."

The panel forecast surpluses of 100,000 to 150,000 doctors, 200,000 to 300,000 nurses and 40,000 pharmacists over the same time period. It said the dwindling number of hospitals will be accompanied by an increased focus on primary care, community-based clinics and out-patient services.

The study acknowledged that despite the glut, many Americans lack adequate health care. But it said the oversupply problem would be a drain on public education budgets during a time of limited resources. It costs taxpayers $200,000 to train one physician, commission officials said.

The most likely response to the problem by medical school officials will be to reduce class sizes rather than close their doors, the study said. But that would result in an anemic, less cost-efficient training system, the report cautioned.

"We're not naive," O'Neil said. "We don't believe that deans will throw themselves on their swords" and shut down entirely. But when medical schools are transformed from cash cows to "a hemorrhage of red ink" in campus budgets, university presidents may change their minds about closing them, he said.

The most likely to survive a shakeout are Ivy League medical centers doing cutting-edge biomedical research and schools that have already shifted their mission to producing primary-care providers. The most likely targets for closing, meanwhile, are middle-tier campuses focused on producing subspecialists.

The study also recommended the following:

- A reduction in the number of first-year medical students from 17,500 in 1995 to between 13,000 and 14,000 in 2005.

- A tightening of immigration laws to ensure that foreign students return to their native countries after they complete training.